Creating Short-Stay Environments For The Chronically Ill
Bridging the gap between inpatient care and off-site clinics, health systems are experimenting with cost-effective, short-stay settings to treat and stabilize “frequent flyer” patients with multiple chronic conditions.
These sometimes frail, mostly elderly patients would otherwise frequent the ED; instead, they benefit clinically from both programs and place that improve access and create a better patient experience. As healthcare designers, this affords an opportunity to develop a new—potentially unique—healthcare setting.
As an intensive outpatient care program or “extensivist clinic,” this model utilizes a physician concentrating on fewer patients who require significant clinical management. The physician is often an intensivist, who typically specializes in attending to the most critically ill patients in the hospital. The patient can also be supported by a multidisciplinary team (nutritionists, social workers, etc.).
Patients may be stabilized in the clinic prior to being discharged to their homes after an inpatient stay or referred for follow-up by the hospital after being discharged. Patients can also be referred from physician practices and skilled nursing facilities, so they’d be stabilized there rather than admitted to a hospital. Typically, the program is based on a hospital campus to take advantage of staff resources.
This model of care has been launched successfully in Europe, but I wanted to research where the extensivist clinics had been adopted in the U.S. One example is being developed by Novant Health in North Carolina.
I interviewed Dr. Larry Weems, who is constructing a day hospital extensivist clinic planned by BBH Design. The clinic is on the first floor of the new 96,000-square-foot addition to the existing Clemmons Medical Center in Clemmons, N.C., opening in March 2017.
Weems said the project is in response to population health studies two years ago that showed 4-5 percent of chronic patients were generating 45 percent of hospital costs in their region. His hope was that hospital-level care could be provided at a better price point in this type of setting, creating higher levels of patient satisfaction.
This facility will also serve as a bridge between urgent care and emergency services. The area will be open 24/7 and is expected to have 75 percent planned and 25 percent unplanned patient visits. Planned visits will include post-procedural follow-up; specialized critical symptom management for palliative care, heart failure, and cellulitis patients; and outpatient infusion. No telemetry monitoring is planned.
Since Novant Clemmons is a small community hospital, a freestanding model for just the extensivist service was not yet economically feasible.
The clinic planning reflects this multifaceted mission. BBH Design led process mapping with the hospital during a Kaizen event, exploring how the area could serve multiple needs.
For example, directly accessible from the drop-off and lobby, there are six private treatment rooms as well as 10 open infusion bays, since many patients returning to the hospital require IV hydration or drug therapy. An average stay lasts around four hours.
For family meetings, there are two private consult rooms and an adjacent education/conference room. The patient area has large windows that overlook a planned healing garden and views beyond.
Reimbursement for this more intense outpatient care model is still being negotiated throughout the U.S. However, in the future, an outpatient short-stay facility for patient follow-up or stabilization outside of the emergency department or inpatient unit could provide a less stressful and convenient setting for the elderly or those with comorbidity.
A flexible universal care unit within the hospital may also provide an appropriate venue. Early involvement by healthcare facility planners can help shape the best environment for this new approach.